Healthcare Provider Details

I. General information

NPI: 1124118880
Provider Name (Legal Business Name): ERICH GEORGE WUNSCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 SIXTH AVE
BROOKLYN NY
11209
US

IV. Provider business mailing address

7317 SIXTH AVE
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-921-5194
  • Fax: 718-921-4780
Mailing address:
  • Phone: 718-921-5194
  • Fax: 718-921-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number040859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: